A 'missed opportunity' to prevent cancer

Presidential panel calls for boost in lagging HPV vaccination rates among U.S. adolescents

Feb. 10, 2014

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By Mary Engel

The number of U.S. adolescents receiving the human papillomavirus vaccine against cervical and other cancers has stalled well below the goal set by public health experts, resulting in “countless missed opportunities” to prevent disease and posing a “serious but correctable threat to progress against cancer,” according to a report released Monday by the President’s Panel on Cancer.

In 2012, only about one-third of 13-to-17-year-old girls received all three recommended doses of the vaccine, far short of the U.S. Department of Health and Human Services’ goal of 80 percent, the report said. Fewer than 7 percent of U.S. boys received the full round of vaccinations.

The Centers for Disease Control and Prevention estimates that increasing HPV vaccination rates to 80 percent would prevent an additional 53,000 future cases of cervical cancer in the U.S. among girls who now are 12 years old or younger over the course of their lifetimes. Vaccination would also likely prevent thousands of other HPV-associated cancers, according to the panel report, including genital-tract cancers and throat cancers.

The panel, a three-member, presidentially appointed advisory group, called on President Obama to make increasing HPV vaccination rates “an urgent public health priority.”

“No man or woman should have to suffer or die from cancers or other diseases when the means by which to protect them is within our grasp,” the panel said in a letter to the president.

A team of researchers from Fred Hutchinson Cancer Research Center and the University of Washington, led by Dr. Denise Galloway, associate director of Fred Hutch's Human Biology Division, was instrumental in laying the groundwork for the HPV vaccine. Galloway and her colleagues also played a pivotal role in identifying how HPV causes cancer.

Galloway, who took part in panel workshops, called the report important for raising awareness of HPV and of the vaccine.

Nearly 80 million people in the United States—1 in every 4—are infected with at least one strain of HPV. Most do not know they’re infected, and in most cases, the immune system is able to clear the virus within two years. But persistent infection with certain types of HPV is associated with multiple cancers. Cervical cancer is the most common, afflicting about 12,000 women in the U.S. each year and almost half a million worldwide. HPV is also linked to cancers of the vulva, vagina, anus, penis and oropharynx (the middle part of the throat including the soft palate, the base of the tongue and the tonsils).

The U.S. Advisory Committee on Immunization Practices recommends vaccination for males and females ages 11 to 12, with “catch-up” doses for females up to age 26 and males up to age 21 who were not vaccinated earlier in adolescence. Receiving the HPV vaccine at ages 11 to 12 offers earlier protection against infection, and preteens have a better immune response to the vaccine than older teens. The vaccine has been recommended for females since 2006 and for males since 2011.

Because HPV is a sexually transmitted infection, some parents have resisted the vaccine because they feared it would encourage teenagers to have sex or to have riskier sex. However, a study conducted by the Cincinnati Children’s Hospital Medical Center in Ohio and published earlier this month in the journal Pediatrics found that receiving the vaccine did not change sexual behaviors.

Other disincentives to HPV shots include inconvenience and cost: The vaccine requires three doses at least two months apart and costs about $400 altogether, although it is often covered by insurance.

But one of the chief obstacles, according to the report, is that pediatricians and family doctors simply don’t routinely recommend the HPV shot along with other vaccines for adolescents such as meningitis and whooping cough boosters.

To address this, the report calls for public education campaigns to raise awareness of the vaccine’s benefits among parents, caregivers, adolescents and family physicians.

The vaccine, said Fred Hutch’s Galloway, ends up being conflated with sexual activity, something that many people are uncomfortable talking about. But the real message, she said, is that this vaccine is actually capable of preventing certain kinds of cancer.

“From a scientist’s standpoint,” she said, “when you make something that’s really useful and can have a large impact on public health, it seems like a no-brainer that it should be adopted.”